Although intensive insulin therapy in the critically ill remains controversial and a matter of much debate, hyperglycemia is common in the critically ill ED patient
Hyperglycemia is associated with worse outcomes in this patient population
When treating hyperglycemia in the critically ill ED patient, use caution with subcutaneous insulin
Absoprtion of insulin administered subcutaneously is slow, erratic, and highly variable often due to poor perfusion, hypotension, and/or vasopressor therapy
In these patients, IV insulin is a better route of administration and leads to more reliable control of hyperglycemia
Recall that the onset of action of insulin given IV is 10 - 30 minutes, with a duration of action of about 1 hour
References
Shipman K, Frankel HL. Do not use subcutaneous insulin in the intensive care unit population. In: Marcucci L, et al. Avoiding Common ICU Errors. Lippincott Williams & Wilkins; Phildelphia, PA, 2007
